Remote Medical Director, Utilization Management

HJSRLLC; Henderson (NV); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

100% remote

Job summary

HJSRLLC is seeking a Medical Director of Utilization Management to lead the clinical integrity of UM functions, focusing on inpatient and post-acute reviews for Commercial and Medicare Advantage members.

The role requires MD or DO with an active license, board certification, and 5+ years of clinical practice including 3+ years in UM or health plan leadership. This 100% remote opportunity reports to the Chief Medical Officer and starts immediately.

Qualifications

• Active MD/DO with unrestricted license.
• Board-certified in a medical specialty.
• 5+ years clinical practice with 3+ years in utilization management or health plan leadership.
• Experience supporting Commercial and/or Medicare Advantage lines.

Responsibilities

• Lead UM reviews for inpatient admissions and post-acute settings.
• Apply guidelines to determine medical necessity.
• Lead complex case reviews.
• Conduct peer-to-peer discussions with clinicians.
• Collaborate with Care Management and UM teams.
• Support quality and regulatory audits.
• Ensure compliant documentation.

Skills

MCG guidelines

InterQual

CMS criteria

Utilization management

Clinical leadership

Peer-to-peer discussions

Documentation & compliance

Communication skills

Education

MD or DO degree

Active medical license

Board Certification

Tools

EMR systems

Microsoft Office

Excel

Job description

HJSRLLC is seeking a Medical Director of Utilization Management to lead the clinical integrity of UM functions, focusing on inpatient and post-acute reviews for Commercial and Medicare Advantage members.

The role requires MD or DO with an active license, board certification, and 5+ years of clinical practice including 3+ years in UM or health plan leadership. This 100% remote opportunity reports to the Chief Medical Officer and starts immediately.